Gender blindness

One in four adults will, during their life, suffer a mental health
problem. GPs already struggle to cope with emotionally vulnerable
patients, a frailty so often closely linked to social or economic
difficulties. And for many women in crisis the problem is
compounded by the gender-blind aspect of the mental health services
currently on offer.

So do women need gender-specific provision? Certainly they need
gender-specific understanding as part of their overall care. They
need a recognition and understanding of the many problems that may
directly arise from their femaleness; disappointment in the failure
of close relationships, the emotional burdens of children, issues
of achievement or the lack of meaningful work. Despite the talk
about post-feminism and girl power, many women still feel a lack of
entitlement, visibility or significance.

A number of practical initiatives have over the years acknowledged
this need, such as the Drayton Park project in London, which has
provided a pioneering service to women in crisis for nearly 10
years. Drayton Park’s provision of single-sex residential care
recognises the dislocating effect of hospital for many women, who
might have a history of domestic or sexual assault. Women are also
allowed to take their children to stay with them.

One of the most innovative developments in psychotherapeutic
services in the 1970s was the Women’s Therapy Centre which spawned
a generation of women therapists who have pioneered work on
gender-linked problems including rape, incest, eating disorders and
social isolation.

The centre takes a refreshingly un-post-feminist approach to
women’s mental health problems, when it announces that it “helps
women to see their issues as part of their upbringing and
education”.ÊÊ

Even so, we must go wider than mere gender-based solutions. A woman
in distress may legitimately want to talk to a woman psychiatrist
or counsellor. She must rightly be allowed to refuse treatment on a
mixed-sex ward. But the next question must be: who and what is that
woman professional? What is the ethos of the consulting room or the
residence, whether mixed- or single-sex, women-oriented or not in
motive and intent?

Sadly, conventional psychiatry and its many sibling disciplines,
such as psychoanalysis, psychotherapy and counselling, have their
fair share of insufferable orthodoxy and sanctimony. One finds such
attitudes in female as well as male practitioners; professionals
reared on an intellectual diet of Freud or Klein who talk without
irony (or worse, with irony) about the “good breast and the bad
breast”, projective identification and their patients’ supposed
fear of the “break”. Within such a schema, apparently, everyone –
rich, poor, black or white – can be analysed alike.

But the work of more socially aware writers such as the now retired
Nottingham NHS consultant, David Smail, is a welcome antidote to
this kind of highfalutin patronage. Smail argues that a lot of
people’s distress is completely understandable given the lives in
which they find themselves: bad education, bad marriages, bad
housing. To concentrate almost entirely on their inner world,
gendered or not, is to provide, at best, a limited treatment, at
worst a damaging one.

In a different context, the houses run by the Philadelphia
Association, a radical psychotherapeutic organisation, offer men
and women a chance to live together over the long term. The
emphasis here is on acceptance, rather than hurried recovery. Many
residents stay in an association house for years, compared with the
average 19 days at Drayton Park

The notion of acceptance lies at the heart of these alternative
approaches to therapeutic work. But it sits uneasily within both an
NHS obsessed with targets and results and a private practice hung
up too often on prestige and making money.

Like men, women in crisis need a simple embrace of inevitably
highly complex individual experience. They need support not just
with life decisions – moving out of a bad relationship or trying to
find work – but much simpler questions such as how to be in a room
with others. In a sense they need to learn skills that are lacking
even in so many of the apparently sane; how to accept our
ordinariness, how to take up our proper place in the world; in
short how to be human. For that they need not an all-powerful
professional but a steady unjudgemental friend, who has the nerve,
kindness and patience to stay the course with them. But then, so do
we all.

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